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HEADACHE IN CHILDREN


Headache we generally see in adults is observed in children with the age frequently. Don’t ignore the headache to be the symptom of severe disorders. Headache is a frequent symptom observed in the society. About 91% of men and 96% have a headache at least once a year. Frequency of headache in children increases by the age. While it is 20-24% in pre-school period, it is 75% in the puberty. 8-10% of patients applying to pediatric neurology for the first time are the patients complaining about headache. 12% of children don’t go to school one day in a year for headache. Studies show that the most frequent type of headache is migraine and it is 3-10% in children. Frequency of headache between the ages of 3-5 is more in boy, it increases in girl after the age of 5 and is observed in equal frequency in both sexes between the ages of 9-11. 

The Reason Of Headache
Headache occurs as a result of physical, chemical or inflammatory effect of structures of head sensitive to the pain. There is no structure perceiving the ache in other words “Nociceptor” in major part of the brain and membrane covering the brain. Structures of the head sensitive to the pain are membranes covering the internal surface of the cranium, periost, veins in the brain, walls of vena and they are scalp and arteries, gingiva and muscles outside of the head. Paranasal sinus diseases, eyes, teeth, head and facial bone diseases may result in headache. 

What’s the risk factor for headache
 • Infections (meningitis, encephalitis, in other words inflammation of cerebral cortex and cerebral tissue, sinusitis, mastoiditis, ENT neck infections)
 • Intracranial hemorrhage, head trauma
 • Space occupying formation (tumor, cyst, hematoma)
 • Systemic diseases (cancers, fever, hypertension, brain edema, hemorrhage, hypoxia in other words oxygen failure, low blood sugar and blood sodium in other words hypoglycemia and hyponatremia) 
 • Epilepsy seizures and post-seizure
 • Procedures (long term tensioning of head during operation, cerebrospinal fluid removal, etc.)
 • Increase of intracranial pressure (drugs, vascular inflammation, hypo-vitaminosis)
 • Tension, depression, anxiety, stress, psychogenic reasons

Types Of Headache 
Acute headache:  Headache starting suddenly and severity of which increases may be sinusitis, ear, eye, tooth infection or the first migraine attack if it is local. If there is widespread pain, it may systemic infection, fever, trauma, hypertension, hypoglycemia, central nervous system infection, electrolyte disorder or the first migraine attack. 

Migraine: It is the most frequent reason of acute- recurrent headache in children. The frequency of migraine in children has increased for the last 20 years. Headache progresses with attacks, uneasiness, shaking head, joylessness, disturbance by light and sound are observed. Pain is felt behind the eye, on the forehead, behind the ears and is often bilateral and shooting. Vomiting, nausea accompanies the ache. The ache may be triggered by stress, fatigue, lack of sleep, exercise, hunger, noise, travel, cold air, various odors, caffeine, nitrite, monosodium glutamate food. 

Aura migraine: Sensual, visual, motor symptoms shown 30-60 minutes prior to headache are defined as aura (symptoms informing that the ache will start. The most frequent aura in children is the paleness, joylessness, loss of appetite and visual signs.)
Migraine without auro-simple:  Hyperactivity, uneasiness, depression, over thirst and paleness may occur before the pain. This headache may last for 1-72 hours. The person may be disturbed by the light and noise. The patient can sleep 8-10 hours after the severe pain. 

Tension type headache: It occurs due to muscle contraction. Attacks may last for 30 minutes and also 1 week. It is the most frequent headache observed in the society. It is bilateral, causes pressure and is compressive, doesn’t increase with physical activity can extend to behind the head and neck. It is mild and moderate.

Chronic, daily headache: It is the headache lasting for the day and 15 days or more in a month. It was determined that psychological reasons at the rate of 45% accompany this headache.  

Chronic progressive headache: It is the headache with the worst prognosis among all head aches. Reasons such as intracranial pressure increase, mass lesions, tumor, abscess, hydrocephalia should be examined. 

Cluster type headache: It is observed in children and adolescent rarely. It is unilateral and seen behind the eyes. Redness, wetness and nasal flow are observed. 

In which cases is brain imaging performed for children with headache?
 • Very suddenly starting severe headache 
 • Chronic, progressive headache 
 • Abnormal neurological examination findings
 • Abnormal eye movements
 • Headache making the child waking up, vomiting while waking up 
 • Balance disorder with the ache 
 • If he is younger than 3                                                  

Treatment Of Headache
 Patients having headache apply to the hospital when their pain becomes pain, severity increases or disrupts daily life. History should be learnt examination and tests should be carried out and whether headache arises from an underlying reason or not (infection, tumor, bleeding, etc, secondary headache) should be shown. To show that headache doesn’t arise from a serious reason will make the parents and children relax. 

Mild ache and short-term ache in children don’t generally require treatment. Moderate-recurrent or progressive headache and headache having adverse effects on daily life, social life, school should be treated.   

Training of patient and family is significant for controlling headache. Headache log should be prepared with the family.  
   
Non-pharmacological treatments

For especially migraine, avoiding factors known to trigger migraine, determination of foodstuff triggering the migraine, elimination of fabrication food with additive is necessary. 

Regular sleeping, organizing school and homework time, meal shouldn’t be missed and also getting in the school bus as hungry should be prevented.  

School and friend problem is a significant factor to result in headache in children. Cooperation with the school and teacher is necessary. 

Children want to sleep in a dark and quite room in case of headache especially migraine attack and attacks may stop with sleeping and it should be known that it is a proper treatment method. 

Behaviour treatment, relaxing exercises, cognitive treatment, stress management is effective for the control of pain at the rate of 80%. 

Medication
When headache attacks occur 3-4 times a month and/or starts to affect social and other activities, medication approved by the physician can be used to reduce severity and frequency of the pain. If you have used medications more than three and they haven’t had any benefits, psychological factors and depression should be examined. 

During the onset of acute pain, pain killer and anti-nausea and vomiting medicine should be used and resting at a quite room or sleeping may be good. Pain killers shouldn’t be used more than 2-3 times a week. Non-pharmaceutical and medication treatment may be required to be administered in many patients.